Recent advances and future directions in spinal cord stimulation for chronic pain: a multidisciplinary perspective

This review aims to provide a comprehensive, multidisciplinary perspective on recent advancements and future directions in spinal cord stimulation (SCS) for chronic pain management. It emphasizes the evolving science of patient selection, technological innovations, cost-effectiveness considerations, and future direction of SCS in pain medicine.

Significant progress has been made in optimizing patient outcomes through refined patient selection, including validated data driven predictive tool which integrated psychological profiling and standard trial stimulation protocol. Technological advancements such as closed-loop stimulation and new waveform have improved efficacy, durability, and patient satisfaction. While SCS is cost-effective in high-income countries, economic evaluations in low- and middle-income settings, such as Thailand, have not yet considered it a cost-effective treatment due to differences in willingness to pay and the cost of conservative treatment. Future direction of SCS may include, restorative SCS for spinal cord injury, new waveforms such as sub-perception stimulation, and multimodal neuromodulation.

SCS has undergone many significant transformations in recent years. The integration of clinical, psychosocial and technological knowledge are and will be the key success factors of this transformation. Multidisciplinary collaboration, ongoing research, and the adoption of advanced technologies promise to further personalize and advance therapy.